Healthcare Provider Details

I. General information

NPI: 1104570738
Provider Name (Legal Business Name): MARY M ADAMS PA-C
Entity Type: Individual
Gender: Female
Sole Proprietor: N

Provider Other Name: MARY M CASE PA

II. Dates (important events)

Enumeration Date: 02/11/2022
Last Update Date: 05/10/2023
Certification Date: 05/10/2023
Deactivation Date:
Reactivation Date:

III. Provider practice location address

3603 BIENVILLE BLVD STE 102
OCEAN SPRINGS MS
39564-5736
US

IV. Provider business mailing address

2101 HIGHWAY 90
GAUTIER MS
39553-5340
US

V. Phone/Fax

Practice location:
  • Phone: 228-818-9620
  • Fax: 228-818-9750
Mailing address:
  • Phone: 228-497-7576
  • Fax: 228-497-8869

VI. Provider taxonomy

Scope of Practice (Provider specialty)

# 1
Primary TaxonomyN
Taxonomy Code363AM0700X
TaxonomyMedical Physician Assistant
License NumberPA00637
License Number StateMS
# 2
Primary TaxonomyY
Taxonomy Code363A00000X
TaxonomyPhysician Assistant
License NumberPA00637
License Number StateMS

VIII. Authorized Official

Name:
Title or Position:
Credential:
Phone: